How to credential a surgeon

Did you know that insurance enrollment complicated process that can take up to 180 days to be completed? Moreover, surgeons like you have to dedicate lots of their time & effort to the preparation of each application form. The struggle always begins before the enrollment process is even started.

Now, you may wonder if it is worth it to participate with insurance carriers. While out-of-network rates can indeed be very attractive, it is still better to be enrolled with at least some major insurance. As a mental health provider, you will have greater access to patients in need when you are active with many benefit plans.

Our billing experts have made a simple, 4-step strategy that can help you enroll with insurance payers quickly and for good:

·  Research, evaluate, estimate

The first critical action that you would need to take is to find out what insurance payers would be more beneficial to your practice. Not all benefit plans are equal, and there is absolutely no need to submit an application to each and any insurance carrier. To put it simple, you should only be interested in payers that will bring you the most revenue. Two things need to be kept in mind:

•      Your location
•        Your provider specialty

If you know that many patients in your geographical area are covered by insurance A – prioritize your enrollment with this payer over all other insurances and plans. Such information can be obtained after doing your own research or after talking to your peers. For example, once you know that most people in your block, borough, or city are Medicaid beneficiaries, it is logical to enroll with a commercial Medicaid Managed Care plan as soon as possible. In addition, it is always worth it to find how certain insurance carriers pay providers from your specialty. Cheap ends do not justify the means!

Once you have made a list of payers that will bring you the most, it is time to inquire on their enrollment panels. Depending on their openness to mental health providers, you will then need to make a list of payers that you would prefer to be enrolled first.

·  Verify, collect, check

Each insurance has its unique enrollment requirements. While they may differ in details, usually, there is a universal package of documents that mental health providers need to submit. It includes the following paperwork:

• ·       Malpractice Insurance
• ·       License
• ·       CV
• ·       Diplomas of education
• ·       Record of disciplinary action
• ·       W9 form
• ·       Voided check
• ·       Enrollment application form

However, we encourage you to get in touch with your desired insurance to find out which documents are needed. Once you have verified this information and collected all the paperwork, please make sure to check if anything is missing. Insurance credentialing does not tolerate mistakes. If any of the required documents are not attached to the application form, the enrollment process will definitely take more than 180 days.

·  Submit, confirm, follow-up

Once you collect the required paperwork, it is time to submit it to the payer. While some insurances use CAQH portal, others still accept the documentation by fax, email, or mail. It is critical to contact the payer and find out if the package has been received in about two weeks since the submission date. Please keep in mind that you may receive a call from an insurance to verify your credentials upon the enrollment process. In general, this is the most time-consuming part of the process, so please allow your desired payer some time to process your application.

·  Review, sign, enjoy

Once the payer processes your documentation – you will receive your enrollment contract. Make sure to review it thoughtfully, especially when it comes to your unique provider fee schedule and an effective date. Discrepancies would be extremely hard to fix in the future.  If everything suits you well – bon voyage, sign the contract!

And if all this sounds too complicated to you, remember, We Can Help you enroll with any insurance carrier you want. Throughout the two decades of our experience, we have credentialed dozens of surgical providers. Contact us!